(WOMENSENEWS)–Last year Denielle, 32, was excited about giving birth to her first child. Her pregnancy was going smoothly until one month before her due date, her water broke. She went to the hospital and 19 hours later she was getting prepped for a C-section.

"I didn’t have any contractions and from the monitor, the baby was not in distress," recalls Denielle, who asked that her last name be withheld. "I was dilated at one centimeter, but my doctor kept insisting that a C-section would be the best thing for the baby even though I wanted a vaginal birth."

The surgery went fine and Denielle delivered a healthy baby, but she was left with the impression of being pressured into having a C-section.

Nearly 1-in-3 U.S. babies are now delivered by Cesarean, compared to 1-in-5 a decade ago.

Among black women, Cesareans are slightly more common, representing 34 percent of births in 2007–the last year data was collected–up from 22 percent in 1996, according to a recent report from the Atlanta-based Centers for Disease Control and Prevention’s Center for Health Statistics.

Researchers point to many factors behind the rise in C-sections. Older mothers, multiple births (due to fertility drugs) and bigger babies all contribute. Medical issues such as diabetes, hypertension–particularly among African Americans–are also causing complications during labor and ultimately leading to more emergency C-sections.

Litigation-shy doctors practicing defensive medicine is another factor. In an study published in the journal Obstetrics and Gynecology last year, nearly a third of the 5,644 doctors surveyed said they were performing more C-sections because they feared lawsuits. Eight percent said they had quit delivering babies, and nearly a third of those said it was because of liability issues.

Financial Incentives

Desirre Andrews is president of the International Cesarean Awareness Network, an organization with a mission to prevent unnecessary Caesareans. She sees financial incentives driving the rise in C-sections.

New York City’s largest public hospital, Bellevue Medical Center, and one of the city’s larger private hospitals, Lenox Hill, show how much more medical money is involved with C-sections.

In 2007 at Bellevue Hospital the average fee for a C-section was $9,839; for a vaginal birth it was $1,912.

At Lenox Hill Hospital, the average fee for a C-section was $20,975; for a vaginal birth, $8,530.

EmblemHealth, formerly HIP Health Plan of New York and GHI (Group Health Incorporated), covers nearly 3.3 million people with access to more than 106,000 health care providers in New York, New Jersey and Connecticut.

The company spokesperson says the hospitals in its network are not profiting from C-sections and neither are the physicians, who receive the same payment for a vaginal delivery as for a C-section. But even though the physician’s payment is the same, other expenses drive up the costs of C-sections, says Ilene Margolin, senior vice president for public affairs at EmblemHealth, citing a longer average length of hospital stay, anesthesiology fees and higher complication rates.

"Hospitalization costs for the infants delivered by Cesarean sections are also higher as these babies have a higher likelihood of requiring neonatal intensive care unit services," Margolin says.

Convenient Scheduling

Susan Pisano, vice president of communications for America’s Health Insurance Plans, based in Washington, D.C., says doctors also sometimes prefer the scheduling convenience of C-sections but insurers try to curb rates of the surgery.

"I don’t think anybody gains if the rates are high because surgery is so risky. It’s a dangerous proposition. Everyone benefits when women who need it get it and when women who don’t need it, don’t get it," Pisano says.

In New York City and many urban centers across America, a higher C-section rate, particularly among African American women, has been closely linked to higher maternal mortality. Black women in New York City die during pregnancy and childbirth eight times as often as white women, according to a report released last year by the city’s health department, and 79 percent of all women who died from pregnancy-related causes had a C-section.

Aetna, another major health insurer, has begun a public education campaign to reduce early deliveries that are not medically necessary. Christine Erb, communication director at Aetna, based in Blue Bell, Pa., says the company has started to survey and praise facilities with safety guidelines for electively scheduled deliveries prior to 39 weeks. Aetna also mails letters to pregnant members about the benefits of waiting the full 39 weeks to deliver.

A least one-fourth of all U.S. births are paid for by Medicaid. Like Aetna and Emblem, the government health program says it does not gain anything from high Cesarean rates.

"Like many states, New York has seen an increase in C-sections over the past 20 years," says Peter Constantakes, spokesperson for the New York State Department of Health. "The New York State Department of Health recognizes that in certain cases C-sections are warranted; however, they do increase the risk for mother and baby and should be undertaken only when medically necessary."

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L. Hunter is a New York-based freelance writer.